Provider Demographics
NPI:1477197457
Name:ELDER & ASSOCIATES ENT-FACIAL PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:ELDER & ASSOCIATES ENT-FACIAL PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-269-3106
Mailing Address - Street 1:17005 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4828
Mailing Address - Country:US
Mailing Address - Phone:717-269-3106
Mailing Address - Fax:302-336-4328
Practice Address - Street 1:17005 OLD ORCHARD RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4828
Practice Address - Country:US
Practice Address - Phone:717-269-3106
Practice Address - Fax:302-336-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty